Administrative Page for
Blue Shield Employer Group Plans

Blue Shield Website forms & Applications

Compare one plan to another and even this year to last year!

Summary of Benefits

Plan Documents

2019 Underwriting Guidelines

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Documents Library

Find useful documents from across the small business Broker Connection pages organized from A to Z.

2019 Employee Application – January 1, 2019 – March 31, 2019 | Spanish
2019 Master Group Agreement – January 1, 2019 – March 31, 2019 | Spanish
2019 Network Guide
2019 Plan Cheat Sheet
2019 Request Contract Change – January 1, 2019 – March 31, 2019 |Spanish
2019 Subscriber Change Request – January 1, 2019 – March 31, 2019 | Spanish
2018 Employee Application – October 1, 2018 – December 31, 2018 | Spanish
2018 Enrollment Spreadsheet
2018 Enrollment Spreadsheet Guide
2018 Master Group Agreement – October 1, 2018 – December 31, 2018 | Spanish
2018 Network Guide
2018 Producer Agreement
2018 Request Contract Change – October 1, 2018 – December 31, 2018 | Spanish
2018 Subscriber Change Request – October 1, 2018 – December 31, 2018 | Spanish
Accelerated Death Benefit Claim
Access to Care
Additional Contact Designation: Notice of Lapse or Term of Policy for Non-Payment
Authorization to Disclose Health Information
Beneficiary Affidavit
Beneficiary Change Request
Eligibility/Participation Attestation
Standard Drug Formulary
BlueCard Worldwide International Claim
Book of Business Transfer Request
Broker Direct Deposit Authorization Form
Bundled Savings
Cal-COBRA Dental Election
Cal-COBRA Election
Cal-COBRA Take Over
Carrier Risk Management Assessment | Spanish
Changes To for HMO Mirror
Changes To for HMO Off-Exchange
Changes To for PPO Mirror
Changes To for PPO Off-Exchange
Changes To for PPO Savings Off-Exchange
Changes To Medical Plan Names
CMS Reporting
COBRA Employee Application
Continuing Group Coverage after Federal COBRA Cal-COBRA Election
Conversion to Individual Coverage of Group Life
CVS Caremark RX Mail Order
Declaration of Disability of Over Age Dependent Children
Dental Brochure for Brokers
Dental Claim
Dental Implant Benefit FAQ | Spanish
Dental Network Map
Dental Nomination Form
Dental Plan Competitive Highlights
Dental Smile Rollover Rewards
Direct Elite Rewards
Dismemberment Claim
Employee Change/ Cancellation Transmittal
Employer Notification of Qualifying Event under Cal-COBRA
EPIC Hearing Aid
Express Enrollment
Find A Doctor
Group Check by Fax Form
Group Information Update
Guide to Manage Dental Plan Online
Heal
Introducing Tandem PPO
Life Insurance Brochure for Brokers
Managing your Vision Plan Online
Member Guide to Orthodontic Coverage | Spanish
Notice Informing Individual about Nondiscrimination and Accessibility Requirements
Notification of CMS Reporting Requirements
Online and Mobile Tools
Pediatric Dental and Vision Coverage
Pharmacy Reimbursement
Premium Only Plan (POP)
Preventive Health Drugs

Preventive Health Guidelines | Spanish

Print or Order ID Card
Privacy Policy | Spanish
Proof of Death
Quick Match Program
Rate Disclosures January-March 2018
Rate Disclosures October-December 2017
Refusal of Coverage
Relaxed Participation
Request for COC Notice – HMO Enrollees
Request for COC Service – Members or New Enrollees
Sales Brochure – Q1 2019
Sales Brochure – Q4 2018
Sales Brochure – Q3 2018
Sales Brochure – Q2 2018
Small Business Tiered Pharmacy Network CA Level A Pharmacy Directory
Shield Concierge
Small Business Online Roadshow Presentation | Recording | Questions Answered
Small Group Producer of Record Change Request
Sole Proprietor, Partner of Corporate Office Statement
Specialty broker bonus
Specialty Drug List for Standard Drug Formulary
Specialty Wellness Discounts
Subscriber Statement of Claim
Subscriber Statement of Claim – Life
Summary of Benefit FAQ
Teladoc
Tiered Pharmacy Network
Trio Flier
Trio Qualification Tool
Total Health and Wellness | Spanish
Vaccine List
Vision Brochure
Vision Claim
Vision Network at a Glance
Vision Plan Info Card for CA Members | Spanish
Vision Plan Info Card for Out-Of-State Members
Waiver of Premium Claim
What’s New – Q1 2019
What’s New – Q4 2018
What’s New – Q3 2018
What’s New – Q2 2018
Why Blue Shield | Spanish
Why Blue Shield Small Business
Women’s Preventive Health
Easy steps to print or order your ID card (PDF, 349KB)
Online and mobile tools (PDF, 575KB)
Access to Care (PDF, 101KB)
2018 Group Administrator’s Guide   A comprehensive guide for your clients that covers a range of information from a list of contacts to instructions for enrollment, payments and other processes.
Forms & Applications on Blue Shields Website
Forms & Applications on Blue Shields Website
Blue Shield Small Group Administrative Guide Rev 1.2015 Current 8.2017
2018 Group Administrator’s Guide

Underwriting Guidelines 2017

Plan Documents – SBC and EOC

 

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With our new streamlined renewal process, you now can:

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Employer Connection Plus – Video Library

PPO Treatment Cost Estimator

Member flier  |  Member step-by-step flier  |  Employer flier  |  FAQs

♦  VideoBlog – Insure Me Kevin.com

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Quotit Enrollment, Applications  & Misc. Forms
Scroll down the page to Blue Shield

Find EOC’s – Evidence of Coverage for Employee Distribution  bscabook.com

eligibility support line at 800-303-5921

 

Producer Connection: For All Renewal Forms and Benefit Summaries. https://www.blueshieldca.com/producer

GROUP SERVICES: Confirm Member Enrollment and Terminations Phone – 800-325-5166, option 1 Producer’s Online Client List: https://www.blueshieldca.com/producer

SUBMITTING GROUP CHANGES/REQUEST FOR CHANGE FORMS: Fax – 209-367-6603 (please retain your fax confirmation) EMAIL: [email protected]

SUBMITTING NEW EMPLOYEE APPLICATION & SUBSCRIBER/MEMBER CHANGES:

Fax – 209-367-6475

EMAIL: [email protected]

BILLING QUESTIONS? Phone – 800-325-5166

UNDERWRITING QUESTIONS/RECERTIFICATION STATUS: 888-834-4263

CLAIMS AND BENEFIT QUESTIONS:

PPO DMHC Plans – 800-200-3242

HMO/POS – 800-424-6521

PHARMACY/DRUG COVERAGE QUESTIONS? – 800-535-9481

Cal – COBRA: Phone – 800-228-9474.

 

Other Pages in the Blue Shield Section

 

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